While wearing double masks, which helps create a strong barrier against Covid-19 infection spread via airborne viral particles, has become the new normal, prolonged wearing of masks can develop hydration issues or other nagging breathing troubles, health experts said on Wednesday.

There has been enough evidence through the pandemic to show the importance of masks for effective pandemic control. At the start of the pandemic, it was seen that countries (primarily Asian nations) which enforced early masking had lesser mortality rates as compared to countries in the West where compulsory mask wearing was introduced quite late.

“Prolonged mask wearing can be associated with certain problems — the most common being headaches, dehydration, acne and difficulty in breathing,” Radhika Banka, Consultant Pulmonologist at P.D. Hinduja Hospital & MRC, Mumbai, told IANS.

Breathing issues are “usually seen in mouth breathers and in people with underlying respiratory problems such as COPD (Chronic Obstructive Pulmonary Disease)”, she added.

According to Ravi Shekhar Jha, Additional Director and HOD, Pulmonology, at Fortis Escorts Hospital, Faridabad, wearing double mask for long hours can also lead to dryness.

“It is because natural humidification of nasal mucosa gets impaired,” Jha said.

There are various masks available in the market, including cloth masks, surgical masks and respirators such as N-95s.

The cloth mask has the least protection and the US Centre of Disease Control and Prevention (CDC) recommends wearing a disposable surgical mask along with a cloth mask for additional protection. For surgical masks, the knotted technique (that is knotting the ear loops to provide better fit and prevent leakage from the sides) is recommended.

But with full vaccination rolled out in most countries, are double masks still required?

“Even after double dose vaccination, people can get breakthrough infections and can still be asymptomatic carriers and spread the infection. Hence masking is important even after double vaccination,” Banka said.

The health experts stated that for people living in India, double masks become more important as vaccination of children has not yet begun in the country, and asymptomatic transmission is the highest from children. Added to this is a high population density, where social distancing is not practically possible in many cases.

Most of the countries which have made masks voluntary are those in the West with low population density, where social distancing is feasible. These countries have managed to vaccinate more than 80 per cent of their population with two doses. Also, masks in these countries are still recommended in enclosed spaces, public transports, healthcare facilities etc.

“With only 48 per cent of our population being vaccinated with one dose and 25 per cent being vaccinated with two doses, I do not think India can yet take the risk of removing the mandatory use of masks,” Banka said.

However, according to Jha, “A single mask, if worn properly, is sufficient.”

“People who wear double masks, have this tendency of adjusting their masks repeatedly due to breathing issues, and that way the whole purpose of wearing a mask is defeated,” he said.

Jha added that for someone like a healthcare worker, who is in an area with high concentration of Covid viral droplets, an N-95 mask should be worn all the time. For other situations, a normal surgical mask (single) is sufficient.

“We need to ensure that masks are worn properly, with proper seal at nose. Improperly worn masks are more dangerous. It is also important to keep in mind that a mask alone may not protect. One needs to follow hand hygiene as well as maintain social distancing,” Jha advised.

Although several countries have loosened mask restrictions citing vaccine efficacy, various studies and health experts have stressed on the need for continuing wearing masks, even after being fully vaccinated, including booster shots; and following other protective measures such as physical distancing and handwashing.

A recent study led by researchers from the Monash University and the University of Edinburgh analysed more than 30 studies from around the world and found a statistically significant 53 per cent reduction in the incidence of Covid with mask wearing, and 25 per cent reduction with physical distancing. Handwashing also indicated a substantial 53 per cent reduction in Covid incidence.

Most people are able to wear masks fairly well for a few hours, but if your job requires you to wear masks for a prolonged period, it is essential to take adequate breaks to hydrate oneself and prevent any skin problems, Banka suggested.